Provider Demographics
NPI:1659849842
Name:TESO, JENNA (LCSW)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:TESO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8500 E OLD SPANISH TRL APT 17
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-4371
Mailing Address - Country:US
Mailing Address - Phone:520-528-6534
Mailing Address - Fax:
Practice Address - Street 1:4560 E BROADWAY BLVD STE 223
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3558
Practice Address - Country:US
Practice Address - Phone:520-528-6534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-17506104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker